氟比洛芬酯复合小剂量芬太尼用于肝功能不全产妇术后自控镇痛的观察

目的 评估氟比洛芬酯复合小剂量芬太尼在肝功能不全产妇术后静脉自控镇痛(PCIA)的效果与不良反应.方法 90例乙型肝炎肝功能不全行子宫下段剖宫产术患者,ASA分级Ⅱ或Ⅲ级,Child-Pugh分级A级,术中应用腰-硬联合麻醉,术后行PCIA,根据不同用药方法随机均分为A、B、C三组.A组:芬太尼1.0 mg+生理盐水至100 ml;B组:氟比洛芬酯100 mg+芬太尼1.0 mg+生理盐水至100 ml;C组:氟比洛芬酯100 mg+芬太尼0.5 mg+生理盐水至100ml.分别于术后6、12、24和48 h用视觉模拟评分法(VAS)评价镇痛效果;记录24 h内PICA按压次数,观察患者恶心、呕吐、嗜睡、呼吸抑制、异常出血等不良反应的发生情况及术前和术后24 h肝功能的变化情况.结果 三组患者均获得较好的镇痛效果.三组VAS评分及按压次数差异无统计学意义;A、B组恶心、嗜睡等不良反应发生率明显高于C组(P＜0.05);镇痛期间三组均未发生异常出血、呼吸抑制等并发症,三组患者术前术后24 h肝功能变化差异无统计学意义.结论 氟比洛芬酯复合小剂量芬太尼用于肝功能不全产妇术后静脉镇痛效果好,有效减少芬太尼的用量,且降低了不良反应的发生率,对患者肝功能无影响.     

氟比洛芬酯复合芬太尼用于胸科手术后镇痛

目的 观察氟比洛芬酯超前镇痛及复合芬太尼用于胸科手术后的镇痛效果.方法 择期行食管癌或贲门癌手术患者75例,随机均分为A、B、C三组.A组于手术结束前30 min静脉给予氟比洛芬酯100 mg,B组于手术开始时及手术结束前30 min静脉分别给予氟比洛芬酯50 mg,两组PCIA配方均为氟比洛芬酯150 mg加芬太尼0.5～0.6 mg;C组于手术结束前30 min静脉给予氟比洛芬酯100 mg,PCIA配方为芬太尼0.8～1.0 mg.记录术后0、4、8、24 h疼痛视觉模拟评分(VAS评分)、镇静评分及不良反应,记录术后24 h PCIA按压次数及芬太尼使用量.结果 三组患者术后各时点SBP、DBP、HR、SpO2、安静和活动时的VAS评分、镇静评分、术后24 h PCIA按压次数差异均无统计学意义.A、B组术后24 h芬太尼用量明显少于C组(P<0.01).A、B组术后24 h出现恶心、呕吐、嗜睡的患者例数少于C组(P<0.01).结论 氟比洛芬酯复合芬太尼用于胸科手术后PCIA镇痛效果好,能减少术后芬太尼的用量,降低芬太尼所致不良反应的发生率.     

氟比洛芬酯复合芬太尼用于食管癌术后静脉自控镇痛的临床观察

目的 观察氟比洛芬酯用于食管癌术后静脉自控镇痛(PCIA)的效果和安全性.方法 ASA Ⅰ或Ⅱ级食管癌根治术患者60例,随机均分为三组,术后PCIA芬太尼1.0 mg、氟哌利多2.5mg组(A组);术后PCIA芬太尼0.5 mg、氟比洛芬酯100 mg、氟哌利多2.5 mg组(B组);麻醉前静注氟比洛芬酯50 mg,术后PCIA芬太尼0.5 mg、氟比洛芬酯50 mg、氟哌利多2.5 mg组(C组),镇痛药均用生理盐水稀释至100 ml.记录术后1、2、4、8、12、24,36、48 h的镇痛评分(VAS)、Ramsay镇静评分、PCIA按压次数及不良反应.结果 术后PCIA按压次数与各时点的VAS三组间差异均无统计学意义.B、C组Ramsay镇静评分及恶心、呕吐发生率低于A组(P＜0.05).结论 氟比洛芬酯复合芬太尼用于食管癌根治术术后静脉自控镇痛的效果良好,且能减少芬太尼用量,同时降低不良反应的发生.     

地佐辛复合氟比洛芬酯或芬太尼用于开胸手术术后镇痛的比较

目的 比较地佐辛复合氟比洛芬酯或芬太尼用于开胸手术患者术后自控静脉镇痛(PCIA)的效果.方法 择期行开胸手术患者120例,随机均分为三组,术后均行PCIA,镇痛药配方分别为地佐辛30 mg+芬太尼0.5 mg(A组),地佐辛30 mg+氟比洛芬酯200 mg(B组),芬太尼0.5mg+氟比洛芬酯200 mg(C组),均加入托烷司琼6mg,且用生理盐水稀释至100 ml,初始负荷剂量2 ml,背景剂量2ml/h,单次PCA剂量0.5ml,锁定时间15 min.观察并记录患者术后2、4、8、24、48h的VAS疼痛评分、Prince-Henry疼痛评分、Ramsay镇静评分,以及术后24 h内PCA按压次数和不良反应.结果 术后2、4h,A组VAS疼痛评分、Prince-Henry疼痛评分和术后24 h内PCA按压次数明显高于B、C组(P＜0.05).术后2h,A组Ramsay镇静评分明显低于B、C组,术后4、8、24 h高于B、C组(P＜0.05).结论 地佐辛复合氟比洛芬酯可以安全有效地用于开胸手术术后镇痛,而地佐辛复合芬太尼在术后最初数小时内镇痛效果欠佳,不良反应偏高.     

氟比洛芬酯复合不同剂量舒芬太尼用于胃肠外科患者术后静脉自控镇痛效果比较

目的观察氟比洛芬酯复合不同剂量舒芬太尼在胃肠手术患者静脉自控镇痛(PCIA)中的效果和安全性。方法选择ASAⅠ或Ⅱ级择期行胃肠外科手术患者100例,术后行PCIA,背景剂量2 ml/h,按压剂量2 ml/次,负荷量2 ml,锁定时间15 min,药液量100 ml分别含舒芬太尼150μg(A组)、舒芬太尼50μg+氟比洛芬酯200 mg(B组)、舒芬太尼100μg+氟比洛芬酯200 mg(C组)、舒芬太尼150μg+氟比洛芬酯200 mg(D组)。观察并记录术后即刻(T0)、2 h(T1)、4 h(T2)、12h(T3)、24 h(T4)患者镇痛评分(VAS)、Ramsay镇静评分、PCIA泵按压次数及不良反应。结果 C、D组在T2~T4时VAS评分和PCIA泵按压次数明显低于A、B组(P<0.05),T1~T3时B、C组Ramsay评分显著低于A、D组(P<0.05)。术后24 h内A、D组恶心的发生率明显高于B、C组(P<0.05)。结论氟比洛芬酯200 mg复合舒芬太尼100μg/ml静脉自控镇痛可为胃肠外科患者术后提供良好的镇痛效果且不良反应少。     

氟比洛芬酯、氯诺昔康术后镇痛疗效及安全性的观察

目的比较氟比洛芬酯、氯诺昔康用于术后静脉镇痛的疗效和安全性。方法择期手术患者30例,年龄18~65岁,随机分为三组,每组10例。术后镇痛分别为A组:PCIA芬太尼1mg/100ml;B组:术毕前5min静注氟比洛芬酯50mg,PCIA氟比洛芬酯100mg 芬太尼0.8mg 生理盐水至100ml;C组术毕前30min静注氯诺昔康8mg,PCIA氯诺昔康16mg 芬太尼0.8mg 生理盐水至100ml。观察疼痛视觉模拟评分(VAS)、PCA按压次数、芬太尼用量、Ramsay镇静评分、恶心呕吐评分、生命体征、不良反应等指标。结果与A组比较,B、C组患者生命体征较平稳,不良反应减少;B、C组镇痛后4、8、24hVAS低于A组(P<0.05)。氟比洛芬酯镇痛起效快,氯诺昔康起效慢,但镇痛更持久(P<0.05)。结论氟比洛芬酯与氯诺昔康两药在术后镇痛上时效不同,两者与芬太尼复合应用均能提高PCIA镇痛效果和安全性。     

胃肠术后氟比洛酚酯复合不同剂量舒芬太尼静脉自控镇痛效果观察

目的观察胃肠术后氟比洛酚酯复合不同剂量舒芬太尼静脉自控镇痛(PCIA)效果和安全性。方法择期行胃肠手术的120例患者,均采用静脉全身麻醉,术后行PCIA。按照镇痛泵药液种类及舒芬太尼用药剂量的不同平均分为四组:A组舒芬太尼150μg。B组舒芬太尼50μg+氟比洛芬酯200 mg。C组舒芬太尼100μg+氟比洛芬酯200 mg。D组舒芬太尼150μg+氟比洛芬酯200 mg。观察并记录术后即刻(T0)、2 h(T1)、4 h(T2)、12 h(T3)、24 h(T4)患者的视觉模拟评分(VAS)、Ramsay镇静评分、PCIA泵按压次数及不良反应。结果 T2~T4时刻C、D组VAS评分和PCIA泵按压次数明显低于A、B组,差异有统计学意义(P0.05)。T1~T3时B、C组Ramsay评分显著低于A、D组,差异有统计学意义(P0.05)。术后24 h内A、D组恶心的发生率明显高于B、C组,差异有统计学意义(P0.05)。结论氟比洛芬酯200 mg复合舒芬太尼100μg PCIA可为胃肠术后患者提供良好的镇痛效果且不良反应发生率较低。     

氟比洛芬酯术前给药对术后芬太尼镇痛的影响

目的 观察氟比洛芬酯术前给药对术后芬太尼镇痛的影响.方法 60例择期行消化道肿瘤手术的患者随机均分为两组,术后行芬太尼静脉自控镇痛(FUCIA).A组术前15 min静注氟比洛芬酯50 mg,镇痛药液中加芬太尼1 mg;B组镇痛药液中加芬太尼1 mg.记录患者术后3、6、12、24 h的VAS、PCA按压次数及不良反应的发生情况.结果 A组术后各时点VAS和24 h内PCA按压次数均明显低于B组(P<0.05).两组不良反应差异无统计学意义.结论 氟比洛芬酯术前给药能加强术后芬太尼的镇痛效果.     

不同方式氟比洛芬酯复合芬太尼术后镇痛效果的比较:前瞻性、多中心、随机、双盲、对照、平行分组研究

目的 比较不同方式氟比洛芬酯复合芬太尼用于术后镇痛的效果.方法 本研究为前瞻性、多中心、随机、双盲、对照、平行分组研究.选择2010年1月至2010年10月择期行骨科、胸外科、肝胆外科等大中型手术的病人,ASA分级Ⅰ或Ⅱ级,年龄14 ～ 91岁,体重35 ～ 95 kg,采用随机数字表法,将其分为3组,A组:术毕即刻静脉注射氟比洛芬酯100 mg,然后芬太尼1.0 mg用生理盐水稀释至100 ml,进行PCIA;B组:氟比洛芬酯200 mg+芬太尼0.6 mg用生理盐水配稀释至100 ml,进行PCIA;C组:术毕即刻静脉注射氟比洛芬酯100 mg,氟比洛芬酯200 mg+芬太尼0.6 mg用生理盐水稀释至100 ml进行PCIA.3组背景输注速率2 ml/h,PCA量2 ml,锁定时间10 min.分别于术毕、术后4、8和24 h时记录静态和动态VAS评分和镇静评分.术后24 h内记录镇痛有效、过度镇静、恶心、呕吐、瘙痒、头晕、嗜睡和呼吸抑制的发生情况.术后24和48 h时随机选择一个中心B组镇痛泵内容物,取样后进行微生物培养试验.结果 共完成2596例,其中A组875例、B组946例、C组775例.与A组比较,B组术毕、术后4、8和24h时静态和动态VAS评分和各时点镇静评分均降低,C组术毕、术后4、8h时静态和动态VAS评分均降低,术后4、8h时镇静评分升高,2组镇痛有效率均升高,B组过度镇静发生率降低,C组过度镇静发生率升高,2组术后恶心和呕吐的发生率降低,C组术后头晕发生率降低(P＜0.05);与B组比较,C组各时点静态和动态VAS评分、镇痛有效率、恶心、呕吐以及瘙痒发生率差异无统计学意义(P＞0.05),术毕、术后4、8h时镇静评分升高,过度镇静发生率升高,头晕发生率降低(P＜0.05).术后24、48 h时泵内容物标本细菌和真菌培养均为阴性.结论 对于大中型手术病人,氟比洛芬200 mg复合芬太尼0.6 mg PCIA(背景输注速率2 ml/h,PCA量2 ml,锁定时间10 min)术后镇痛的效果更佳,且不良反应发生几率低.     

切口内持续输注氟比洛芬酯对芬太尼静脉自控镇痛的影响

目的 观察切口内持续输注氟比洛芬酯对芬太尼静脉自控镇痛的影响.方法 择期全麻下行椎体融合术的成人患者60例,随机均分为三组:A组,切口内持续输注0.1%的氟比洛芬酯200 ml;B组,静脉持续输注0.1%的氟比洛芬酯200 ml;C组,切口内持续输注生理盐水200 ml.所有患者术后均用芬太尼10μg/ml行患者静脉自控镇痛(PCIA).记录各组患者术后1、4、12、24、48 h静息时和术后4、24、48 h活动时的疼痛视觉模拟评分(VAS)和芬太尼累计用量,同时观察记录术后48 h内的镇静评分、恶心、呕吐发生率及切口愈合情况.结果 A组术后各时点VAS明显低于B、C组,B组明显低于C组(P<0.05).术后48 h的PCIA芬太尼累计用量A组明显低于B组和C组(P<0.05).各组间的镇静评分及恶心、呕吐发生率差异无统计学意义.结论 切口内持续输注氟比洛芬酯用于椎体融合术与静脉输注相比可更显著改善术后芬太尼PCIA的效果,并减少芬太尼累计用量.     

Evaluation of the effect of perineuronal morphine on the quality of postoperative analgesia after axillary plexus block: a randomized double-blind study

A randomized, double-blind study was performed on 50 patients scheduled for elective hand and forearm surgery under axillary plexus block to evaluate the effect of perineuronal morphine on the quality of postoperative analgesia. Patients were divided into two groups. In group A (n = 25) 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline was added to the local anesthetic solution (20 mL of 1% plain lignocaine, 20 mL of 0.5% plain bupivacaine). They also received an intramuscular placebo injection of 1.0 mL of 0.9% saline in the upper thigh. In group B (n = 25), 1.0 mL of 0.9% saline was added to the local anesthetic solution and patients received an intramuscular injection of 5 mg of preservative-free morphine in 1.0 mL of 0.9% saline in the thigh. The addition of morphine to the local anesthetic solution for the axillary block did not shorten the onset time of the block, improve the quality of postoperative pain relief, or provide longer lasting analgesia than that obtained with intramuscular morphine.     

Peripheral opioid analgesia in laparoscopic cholecystectomy

BACKGROUND: Recent research has revealed that opioids can act directly on the peripheral terminals of afferent nerves to mediate antinociception. The aim of this study was to assess the influence of peripheral morphine administration on the nociception process in the postoperative period. METHODS: One hundred fifty patients for laparoscopic cholecystectomy were randomly divided into 5 groups. Group M patients (n=30) received local infiltration at trocar insertion points with 2 mg morphine in 20 mL of 0.9% NaCl solution (5 mL of solution per point) 10 minutes before the operation. For group B patients (n=30), the solution used for infiltration was 20 mL of 0.25% bupivacaine; for group M+B patients (n=30), the solution was 2 mg morphine in 20 mL of 0.25% bupivacaine; and for group S patients (n=30), the solution was 20 mL 0.9% NaCl. For group S+M patients (n=30), trocar insertion points were infiltrated with 20 mL of 0.9% NaCl, and patients in this group were given 2 mg of subcutaneous morphine 10 minutes before the surgery. Postoperative analgesic therapy was provided by on-demand analgesia with tramadol. After surgery, the following were measured: pain intensity scored on the visual analog scale, total tramadol requirement, time from the end of the surgical procedure to the administration of the first dose of tramadol, and the frequency of undesirable side effects (sedation, nausea, and vomiting). RESULTS: Pain intensity and total tramadol requirement after surgery were lower in groups M, B, and M+B compared with groups S and S+M, but these differences were not statistically significant. The time from the completion of the operation to the administration of the first dose of tramadol was significantly longer in groups M, B, and M+B compared with groups S and S+M. CONCLUSION: Results of the study confirm the possibility of modifying the nociception process in the postoperative period through peripheral opioid administration.     

Analgesic requirements for patients undergoing lower extremity orthopedic surgery--the effect of combined spinal and epidural magnesium

BACKGROUND: Polypharmacological approach is the most common practice to treat perioperative pain, as no single agent has yet been identified to specifically inhibit nociception without associated side effects. Opioids such as Fentanyl is commonly added to local anesthetics to produce spinal and epidural anesthesia. However, significant adverse effects, such as pruritus, respiratory depression, hemodynamic instability and occasionally severe nausea and vomiting, may limit their use. Our present study was designed to assess the effectiveness of using combined intrathecal and epidural magnesium (Mg) in reducing intra-and postoperative analgesic requirements and improving the quality of analgesia. METHOD: Eighty patients ASA I, II, III who scheduled for lower extremity orthopedic surgery were included in the study. Patients were randomly allocated to one of two groups, 40 patients each. The Control Group: patients received intrathecal 10 mg of Bupivacaine 0.5% (2 ml), plus 25 microg of Fentanyl (0.5 ml), plus 0.9% NaCl solution (1 ml) and an epidural infusion of 0.9% NaCl at a rate of 5 ml/hr. The Magnesium Group: patients received intrathecal 10 mg of Bupivacaine 0.5% (2 ml), plus 25 microg of Fentanyl (0.5 ml), plus 50 mg of 5% Mg (1 ml) and an epidural infusion of 2% Mg at a rate of 100 mg/hr (5 ml/hr). RESULTS: Intrathecal Mg prolonged fentanyl analgesia as indicated by increased duration of anesthesia in the Mg group, and thus improving the quality of spinal anesthesia. The effectiveness of the postoperative analgesia was confirmed by markedly lower perioperative analgesic requirements (38.3 % less than the Control group), the patient's low VAS score, the longer time for the patients first requirements of post-operative analgesia in the Mg group. CONCLUSION: For lower extremity orthopedic procedure, supplementation of spinal anesthesia with combined intrathecally injected and epidurally infused Mg, considerably reduced the perioperative analgesic requirements without any side effects.     

氟比洛芬酯对喉癌喉裂开术患者围术期细胞因子及术后疼痛的影响

目的 观察氟比洛芬酯对喉癌喉裂开术患者术后疼痛及围术期细胞因子的影响.方法 择期行喉癌喉裂开术患者60例,随机均分为三组:术毕前10 min分别静脉注射氟比洛芬酯1.0mg/kg(F<,1>组)、氟比洛芬酯1.5 mg/kg(F<,2>组)、生理盐水5 ml(C组).VAS评分评定术后1、2、4、68、12、24 h的疼痛程度.监测术前、术毕和术后6、24 h血浆白细胞介素(11)-2、可溶性白细胞介素-2受体(SIL-2R)、IL-6、IL-10的浓度.结果 与术前比较,C组SIL-2R水平在术后6 h明显降低、术后24 h明显升高;F<,1>、F<,2>组SIL-2R水平明显降低;三组IL-6、IL-10水平明显升高和IL-2水平明显降低(P<0.05).与C组比较,术后1、2、4 h时F<,2>组VAS明显降低,术后4 h时F<,1>组VAS明显降低(P<0.05);术后6、24 h时F<,1>、F<,2>组的IL-10水平和术后24 h时的IL-2水平明显升高,且F<,2>组明显高于F<,1>组(P<0.05);F<,1>、F<,2>组在术后6 h时的IL-6水平和术后6、24 h时SIL-2R水平明显降低,且F<,2>组明显低于F<,1>组(P<0.05).结论 1.5 nag/kg氟比洛芬酯能有效地平衡细胞因子,缓解术后的免疫损伤,具有免疫保护作用.     

不同镇痛方法对老年食管癌患者术后疼痛及早期认知功能的影响

目的探讨不同镇痛方法对老年食管癌患者术后疼痛及认知功能的影响。方法选择拟行左进胸食管癌根治术患者60例,男31例,女29例,年龄65~80岁,ASAⅠ或Ⅱ级,随机分为A、B两组,每组30例。A组:关胸前予以0.375%罗哌卡因行肋间神经阻滞后接静脉镇痛泵,配方为舒芬太尼3μg/kg+氟比洛芬酯100mg,泵速2ml/h,自控镇痛0.5ml/按压,锁定时间15min。B组:关胸前予以舒芬太尼10μg+氟比洛芬酯50mg为负荷量后接静脉镇痛泵,配方同A组。观察两组患者术前1d、术后3、5、7d内简易精神状态量表(MMSE)评分,术后苏醒时、苏醒后4、8、12、24、48h视觉模拟疼痛(静息及运动时VAS)评分、BCS舒适评分、术后镇痛泵有效按压次数及术后认知功能障碍(POCD)的发生率。结果与B组比较,A组术后苏醒时、苏醒后4、8、12、24、48h静息及运动时VAS评分均明显降低(P0.05或P0.01);苏醒后4、8、12、24、48h的BCS评分明显升高、有效按压次数明显降低(P0.05);术后3、5、7d的MMSE评分明显升高(P0.05);术后3、5、7d的POCD发生率降低,但差异无统计学意义。结论开胸手术围术期应用肋间神经阻滞复合静脉镇痛可有效缓解患者术后疼痛,降低术后POCD的发生率,提高术后患者舒适度,有利于术后患者的快速康复。     

不同剂量右美托咪啶复合氟比洛芬酯在乳腺术后镇痛中的应用

[摘要] 目的 研究右美托咪啶复合氟比洛芬酯在乳腺术后的镇痛作用。方法 选择ASAI-II级90例全麻下行乳腺手术患者,随机分3组：A组（对照组）,给予氟比洛芬酯150mg;B组,给予氟比洛芬酯150mg+右美托咪啶0.02μg/kg/h;C组给予氟比洛芬酯150mg+右美托咪啶0.04μg/kg/h,生理盐水稀释至100ml。记录手术前（T0）,手术后2h（T1）,4h（T2）,8h（T3）,24h（T4）,48h（T5）时的心率（RR）、血压（BP）、血氧饱和度(SPO2),呼吸（RR）,疼痛（VAS评分法）和镇静评分（Ramsay分级法）。并观察术后48h内有无出现恶心、呕吐、头晕、嗜睡、呼吸抑制等不良反应发生情况。 结果 A、B两组术后血压和心率值均较术前高,C组术后血压较术前高,但其心率较术前低,组间两两比较差异有统计学意义( P<0.05)。镇痛VAS评分2h~8h内B、C两组和A组比较有统计学意义,24h~48h三组比较无统计学意义。2~8h镇静Ramsay评分C组与A、B两组比较有统计学意义。A组恶心、呕吐的发生率大于B、C组,C组嗜睡发生率大于A、B两组,但均无统计学意义。结论 0.02μg/kg/h的右美托咪定与氟比洛芬酯可安全有效地应用于乳腺术后镇痛。     

The analgesic and sedative effects of intrathecal midazolam in perianal surgery

BACKGROUND AND OBJECTIVE: Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. METHODS: Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared. RESULTS: In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups. CONCLUSION: The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.     

Postoperative metabolic acidosis: use of three different fluid therapy models

Intraoperative fluid administration is considered an important factor in the management of metabolic acidosis following surgical procedures. The aim of this study was to compare three types of intraoperative infusional models in order to evaluate their effect on acid-base changes in the immediate postoperative period as calculated by both the Henderson-Hasselbach equation and the Stewart approach. Forty-seven patients undergoing left hemicolectomy were enrolled in the study and assigned randomly to receiving 0.9% saline alone (Group A, n=16), lactated Ringer's solution alone (Group B, n=16) or 0.9% saline and Ringer's solution, 1:1 ratio (Group C, n=15). Arterial blood samples were taken before operation (t0) and 30 min after extubation (t1) in order to measure the acid-base balance. The results showed a metabolic acidosis status in Group A patients, whereas Group B exhibited metabolic alkalosis only by means of the Stewart method. No difference was found in Group C between the time points t0 and t1 when using either the Henderson-Hasselbach equation or using the Stewart model. We conclude that saline solution in association with Ringer's solution (1:1 ratio) appears to be the most suitable form of intraoperative fluid management in order to guarantee a stable acid-base balance in selected surgical patients during the immediate postoperative period.     

氟比洛芬酯超前镇痛用于乳腺癌根治术患者的临床观察

目的:探讨氟比洛芬酯超前镇痛对乳腺癌根治术患者术后疼痛以及全麻苏醒期躁动的影响。方法:选择全身麻醉下乳腺癌根治术患者(ASA I～II级)120例,随机分为A组(麻醉诱导完成后立即给予50 mg氟比洛芬酯,切口缝合完成时再给予50 mg),B组(麻醉诱导完成后立即给予100 mg氟比洛芬酯),C组(切口缝合完成时给予100 mg氟比洛芬酯)D组(对照组,切口缝合完成时换等量的生理盐水),每组30例。比较各组患者术后1,3,6,12,24 h的VAS评分,手术结束时与拔管时的心血管反应,以及全麻苏醒躁动情况。结果:3个观察组术后12 h内各时间点VAS评分均明显低于对照组(均P<0.05),其中A组各时间点均明显低于C组(均P<0.05),在1,3 h明显低于B组,而B组在1,3 h明显低于C组(均P<0.05),术后24 h的VAS评分4组间差异无统计学意义(均P>0.05);手术结束时4组间平均动脉压(MAP)和心率(HR)变化差异无统计学意义(P>0.05),但3个观察组患者拔管时的MAP,HR的变化均小于对照组(均P<0.05),其中A组变化最小,其次为B组和C组(均P<0.05),B组明显低于C组(均P<0.05);各组全麻苏醒期躁动发生率分别为:A组13.3%,B组23.3%,C组33.3%,D组43.3%,各组间的差异均有统计学意义(均P<0.05)。结论:氟比洛芬酯超前镇痛能有效减轻乳腺癌根治术患者术后早期疼痛程度、心血管反应,以及降低全麻苏醒期躁动的发生率。